Association of Physical Function and Survival in Older-Adult Renal Transplant Recipients

There is an increase in older-adult renal transplant recipients in United States. The objective of this study was to assess the association between physical function (PF) and patient survival in renal transplant recipients who are aged 65 years or older. Using United Network for Organ Sharing (UNOS) data from 2007 to 2016, renal transplant recipients aged 65 years or older were included. Multivariable Cox regression was used to assess associations between survival and functional status adjusted for age, sex, race, donor quality, diabetes, and dialysis vintage. The study identified 26,721 patients. Patient survival was significantly higher in recipients who needed no assistance and lowest in patients in need of total assistance (P < .0001). In deceased donor (DD) transplants, the relative risk for mortality was 2.06 (1.74-2.43) for total assistance and 1.17 (1.08-1.28) for moderate assistance compared to no assistance (P < .0001). In living donor (LD) transplants, the relative risk of mortality was 1.38 (0.78-2.42) for patients needing total assistance and 1.37 (1.14-1.65) for patients needing moderate assistance compared to patients who did not need assistance (0.003). PF is an independent predictor of post-transplant mortality. Assessment of older potential renal transplant recipients should include assessment and standardization of functional status to counsel about post-transplant survival.     

Reflecting on exchange students’ learning: Structure,objectives and supervision

Abstract

Background and aim: The increasing opportunities for medical students to participate in international electives may improve students’ professionalism and cultural competence. However, the students’ overall experiences may be unpredictable, unstructured and lack supervision. There is scant evidence with respect to their learning outcomes. These reflections demonstrate that short-term supervised elective can provide students with structured learning experiences to achieve specific learning objectives.

Methods: We carried out daily debriefs and a weekly summary with seven Curtin Medical School students from Perth, Australia during an 18-days supervised elective in the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. The daily debriefs and the weekly summary in different disciplines become the content of the reflections discussed in this article.

Results: The main themes identified in the feedback were as follows: Skills in history taking and physical examination; clinical reasoning; diagnosis and management of diseases rarely seen in Australia; awareness of clinical ethics; merits and demerits of different systems of healthcare; sensitivity to issues in doctor-patient relationships; work ethics; enhancement of cultural competence; and personal development.

Conclusions: These reflections provide insight into how overseas electives may be structured to improve students’ clinical reasoning skills in this hospital. These students achieved their learning outcomes under joint supervision from both institutions. The clinical skills learned from these experiences enhanced the students’ professionalism and cultural competence, giving students the opportunities to appreciate the multitude healthcare model of bio-psycho-social-political-economical-spiritual dimensions.     

The optimal short version of the Zarit Burden Interview for dementia caregivers: diagnostic utility and externally validated cutoffs

Objectives: Using a sample of dementia caregivers, we compared the diagnostic utility of the various short versions of the Zarit Burden Interview (ZBI) with the original scale to identify the most optimal one. Next, we established externally validated cutoffs for the various ZBI versions using probable depression cases as a reference standard.

Methods: Caregivers (N = 394; 236 males; Age_mean = 56 years) were administered the ZBI and a self-report depression measure. Participants who exceeded the cutoff for the latter were identified as probable depression cases. For each of the ZBI versions, a receiver operating characteristic (ROC) curve was plotted against probable depression cases. The area under these ROC curves between the short versions and the original were then compared using a non-parametric approach.

Results: Compared to the original ZBI, the AUROC were similar for the 6-item, 7-item, and two 12-item versions, but significantly worse for the other short variants. The sensitivity and specificity of the cutoffs for all ZBI versions ranged from 77.3% to 85.2% and 60.1% to 79.8%, respectively.

Conclusions: The original ZBI had good utility in identifying probable depression in caregivers, while the 6-item variant can be a useful alternative when short versions are preferred.